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BLDCI-16-005505-05
The Commonwealth of Massachusetts h , r City\Town of YARMOUTH 1- New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:SANDBAR MGT INC. BLDCI-16-005505-05 Trade Name:SHARKBITES Identify property address including street number, name, city or town and county Certificate Expiration Located at 518 ROUTE 28 11/30/2021 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 140 A-3 Amusement/Church/Gym/Library!Museum 40 SEATS INSIDE 100 SEATS OUTSIDE Allowable TOTAL-140 SEATS Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Gryll Date of Building Commissioner Inspection 3-7-a'� Signature of Municipal Signature of Municipal -' Date of Building Commissioner G+�. � Issuance W 00 i 00— e $150.00 BLD CertoflnsnPrtinn rnt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Shark Bite ADDRESS: 512 Route 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for 4 License Issuance !ems No Fire Department Rep. Date Comments Approved for Li -•se Issuance v/\ - 3/9 Ia r No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 . .�z ; TOWN OF YARMOUTH � �a BUILDING DEPARTMENT �µ . ja"DYE �,x�•�..:t Lam,,. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION '" .. '...___I V___ i Febuary 5, 2021 PAYABLE UPON REc 2 4 2021 (X)Fee Require4 15.0.110.__ _____.._.! ( ) No Fee Reg lfd!-DING DEPARTMENT In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 51 8' /nau•4 5// Name of Premises: 5 if Ave K B 1+TE 5 Tel: 9'7 Er- 37 b-S'f oz Purpose for which permit is used: Ca. A-1 License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to S aril dar V'19 vht• I vrc Tel: 91 Fr- 3 7S-CYO — Address: 5-1 & th' ry St• Owner of Record of Building S at n.a(bar 'l+l d .• s, r 4- Address S-/Er Mai)? S -, Present Holder of Certificate .h of ba,r 11't5.m`t, y h c S,w. D ulh E-he Signatur of pe o to Title Certificate is issued or his agent 71/4 9/zo zv Date Email Address: J u e , m a rr4rr1a ® 5 vv7a4.( ,C.Oni Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten(10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION R WE CANNOT ISSUE YOUR CERTIFICATE OF INSPE;TIQl Certificate of Inspection# (5L I—14 J pc / 55 c D ((�)J 4/1/2021 —11/30/21 W l� cJ ACC)RE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) M1f�r' 12/14/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONtAC! NAME: Brian Allain Choice Insurance Agency (PAHONN.Ext): 978-343-4853 _ FAX No): 978-345-1007 376 Summer Street E-MAIL Fitchburg,MA 01420 ADDRESS: ballain@choice-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company INSURED INSURER B: Guard Insurance Sandbar Management Inc INSURER C: P.O.Box 481 INSURER D: West Yarmouth,MA 02673 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RETED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CPS7208009 06/26/20 06/26/21 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 1 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER X RI- AND EMPLOYERS'LIABILITY Y/NANY STATUTE ER B OFFICER/MEMBER OEXCLUDEDXECUTIVE N/A SAWC187858 10/01/20 10/01/21 I E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ Aggregate 2,000,000 Liquor Liability A CPS7208009 06/26/20 06/26/21 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations of Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE Brian Allain ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD